Specimen Submission Guidelines for Pathologic Evaluation of Myocarditis

Download: CDC—10367 Specimen Submission Guidelines for Pathologic Evaluation of Myocarditis [PDF – 310 KB]

Pathogens that cause myocarditis may be distributed focally and sparsely in the heart, despite extensive inflammatory infiltrates in the involved tissues. Because myocarditis can occur in the context of systemic diseases (e.g. Rocky Mountain spotted fever or meningococcemia), or as a manifestation of a primary infection involving another organ system (e.g., influenza), collecting multiple representative portions of cardiac tissue, as well as tissue samples from any other organ system with inflammatory cell infiltrates or other findings suggestive of infection, ensures the best chance of detecting the causative agent. Performance of specific immunohistochemical, molecular, or other assays will be determined using clinical and epidemiologic information provided by the submitter and the histopathologic features identified in the submitted tissue specimens.

Collection of Tissue Specimens

The preferred specimens include a minimum of 2 paraffin blocks of involved heart tissue, or representative tissues in formalin (i.e., wet tissue). Fresh-frozen tissue may also be submitted for culture and molecular-based assays. Specific guidelines for these samples include:

1. Multiple fragments of cardiac tissue representing each anatomic portion of the heart involved by inflammatory infiltrates (e.g., ventricles, epicardium, pericardium)
2. If myocarditis is identified in the context of a systemic illness, representative tissues should be included from any other organ showing significant microscopic pathology.

Submission of Specimens

Paraffin-embedded tissue blocks

In general, this is the preferred specimen and is especially important to submit in cases where tissues have been in formalin for a significant time. Prolonged fixation (>2 weeks) may interfere with some immunohistochemical and molecular diagnostic assays.

Wet tissue

If available, we highly recommend that unprocessed tissues in 10% neutral buffered formalin be submitted in addition to paraffin blocks.

Unstained slides

Although not optimal, if paraffin blocks are unavailable it may be possible to utilize unstained sections cut at 3–5 microns (10 slides per block) for immunohistochemistry and special stains but not molecular diagnostic assays (e.g. PCR).

Fresh-frozen tissue

Send separately on dry ice.

Electron Microscopy (EM) specimens

Samples fixed in glutaraldehyde and held in phosphate buffer. Sample containers are filled to the top with phosphate buffer and sent on wet ice. Do not freeze. Epoxy-embedded tissues are also accepted.

Please refer to our General Guidelines for shipping pathology specimens.